Internal medicine 2014

[firstaidjelly]

The average usmle score this year is ridiculously high -- 227. I have 201 Usmle score step 1 and 410 Comlex 1 score. Is internal medicine possible? Or should I only apply family medicine?

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[Instatewaiter]

IM is possible but you're going to have to apply broadly... What makes you want to do IM over FM? If you want to do outpatient primary care, you'd be better served with FM. If you want to do a specialty or hospital based medicine, IM is the better course.

Assuming you want IM, apply to a combination of mid-tier university programs and community programs. The mid-tier university programs will be your reach schools. It is going to be made slightly more difficult as a DO but still possible. It is not as if you failed either board. IM has a very large range from programs that average USMLE scores in the 250s to those just squeaking by. Finding a program where you are competitive that you like will be important. E-mail programs if you are unsure if you are competitive and ask them

 

[SunsFun]

IM is possible but you're going to have to apply broadly... What makes you want to do IM over FM? If you want to do outpatient primary care, you'd be better served with FM. If you want to do a specialty or hospital based medicine, IM is the better course.

Assuming you want IM, apply to a combination of mid-tier university programs and community programs. The mid-tier university programs will be your reach schools. It is going to be made slightly more difficult as a DO but still possible. It is not as if you failed either board. IM has a very large range from programs that average USMLE scores in the 250s to those just squeaking by. Finding a program where you are competitive that you like will be important. E-mail programs if you are unsure if you are competitive and ask them

Say he wants to specialize after IM residency. Does it mean most community-based programs are out of question?

 

[Instatewaiter]

Say he wants to specialize after IM residency. Does it mean most community-based programs are out of question?

Depends on a few things:
1) What does he want to specialize in?
- if endocrine, geriatrics, nephrology, rheum it is easy to match into from pretty muchb any program. Go where there are fellowships

2) more importantly- can he get into anything other than a community program?
- Depends on the year. It is possible but with scores more than 20 points below the mean, it is probably going to be a tough sell to get into an average or above average program (where most university programs rank).

 

[neusu]

Why does everyone want to do IM as a pathway to a fellowship? These fellowships should just grab the bull by the horns and be like integrated plastics or CT-surgery.

In reality, Most US grads SHOULD want to do IM/FP or GS. SDN is a misrepresentation or interests, mostly because those who aren't naturally in the window of where they want to be, seek advice. Those who are, do not.

 

[Arkangeloid]

Why does everyone want to do IM as a pathway to a fellowship? These fellowships should just grab the bull by the horns and be like integrated plastics or CT-surgery.

In reality, Most US grads SHOULD want to do IM/FP or GS. SDN is a misrepresentation or interests, mostly because those who aren't naturally in the window of where they want to be, seek advice. Those who are, do not.

IIRC, in Europe they do have integrated programs for things like GI and Cards.

 

[firstaidjelly]

This is the person who posted. Not interested in specializing -- just want to open up my own clinic and be my own boss. So FM is better then?

 

[KnuxNole]

If I was to do IM, I would only want to do outpatient...specialization was not anything in my interests....especially ones that had anything to do with surgery/big procedures.

 

[evilbooyaa]

This is the person who posted. Not interested in specializing -- just want to open up my own clinic and be my own boss. So FM is better then?

Depends.

Do you want to see kids/OB/Gyn? If no, then probably do IM and take an outpatient job. If you're OK with doing both of those, then go for FM.

Caveat - You can do FM and not see kids or OB/Gyn, but it will be slightly harder to ensure that.

 

[Snoopy2006]

My 3rd year IM preceptor, who was an internist and worked at an outpatient practice, disclosed to me that he only netted $80k/year. He worked 60-70 hour weeks. This leads me to believe that money is the driving force behind IM residents wanting to pursue either GI or cards or else going the hospitalist route. Outpatient IM seems to be incredibly unpopular. Low pay + long hours. Interestingly IM is an extremely competitive specialty this year.

IM is growing in competitiveness not only due to the fellowships, but because of an increased interest in hospital medicine - good demand, competitive compensation if you understand your market, fairly unique schedules.

$80k seemed almost unbelievably low at first to me, but "netted" is the key word - I suppose after taxes that it's possible. Depressing, but possible.

IM vs. FP: the main difference to me would come down to patient population. Adults only, or adults + kids? While you'd have to stomach OB during your residency training, many FP docs I've worked with drop the OB aspect once they go into practice. Traditionally FP docs also do more procedures in outpatient clinic (derm procedures, etc.).

If you want to do IM with a score of 201, look for community programs that are in non-desirable areas. A lot of solid community programs have trouble recruiting because of location. As far as competitive fellowships - definitely possible after some community programs, but those tend to be the more competitive community programs. As an example, Lutheran General has a GI fellowship and take their own. The non-competitive fellowships, as someone mentioned above, should be fair game coming from most programs.